82R5345 TRH-F
By: Eiland H.B. No. 758
A BILL TO BE ENTITLED
AN ACT
relating to certain limitations in health benefit plans and health
insurance policies.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1201.227, Insurance Code, is amended to
read as follows:
Sec. 1201.227. POLICY PROVISION: INTOXICANTS AND
NARCOTICS. (a) Except as provided by Subsection (b), an [An]
individual accident and health insurance policy must contain the
following provision if the policy addresses the subject matter of
the provision:
"Intoxicants and Narcotics: The insurer is not liable for
any loss sustained or contracted in consequence of the insured's
being intoxicated or under the influence of any narcotic unless the
narcotic is administered on the advice of a physician."
(b) An individual accident and health insurance policy may
not contain the provision described by Subsection (a) if the policy
provides coverage for emergency or other medical, hospital, or
surgical expenses incurred by an insured.
SECTION 2. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1374 to read as follows:
CHAPTER 1374. BENEFITS RELATING TO INJURIES RELATED TO
INTOXICATION OR USE OF NARCOTICS
Sec. 1374.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
emergency or other medical, hospital, or surgical expenses incurred
as a result of a health condition, accident, or sickness, including
an individual, group, blanket, or franchise insurance policy or
insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage or similar coverage
document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842 of this code;
(3) a health maintenance organization operating under
Chapter 843 of this code;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844 of this code;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846 of this code;
(6) a stipulated premium insurance company operating
under Chapter 884 of this code;
(7) a fraternal benefit society operating under
Chapter 885 of this code;
(8) a Lloyd's plan operating under Chapter 941 of this
code; or
(9) an exchange operating under Chapter 942 of this
code.
(b) This chapter applies to:
(1) a small employer health benefit plan written under
Subchapter B, Chapter 1273, or Chapter 1501;
(2) a standard health benefit plan offered under
Chapter 1507;
(3) basic coverage provided under Chapter 1551, a
basic plan provided under Chapter 1575, a primary care coverage
plan provided under Chapter 1579, and basic coverage provided under
Chapter 1601; and
(4) notwithstanding Section 172.014, Local Government
Code, or any other law, health and accident coverage provided by a
risk pool created under Chapter 172, Local Government Code.
(c) This chapter does not apply to:
(1) a health benefit plan that provides coverage:
(A) only for benefits for a specified disease or
for another limited benefit other than an accident policy;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance; or
(F) only for dental or vision care;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
an automobile insurance policy; or
(5) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Subsection (a) of this section.
Sec. 1374.002. EXCLUSION OF COVERAGE PROHIBITED. (a) A
health benefit plan may not exclude coverage for any emergency or
other medical, hospital, or surgical expenses incurred by an
insured as a result of and related to an injury acquired while the
insured is intoxicated or under the influence of any narcotic,
regardless of whether the intoxicant or narcotic is administered on
the advice of a health care practitioner.
(b) Coverage required under this chapter may be subject to
deductibles, copayments, coinsurance, or annual or maximum payment
limits that are consistent with deductibles, copayments,
coinsurance, or annual or maximum payment limits applicable to
other similar coverage under the health benefit plan.
Sec. 1374.003. RULES. The commissioner shall adopt rules
necessary to implement this chapter.
SECTION 3. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2012. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2012,
is governed by the law in effect immediately before the effective
date of this Act, and that law is continued in effect for that
purpose.
SECTION 4. This Act takes effect September 1, 2011.